1-Conflict of Interest Statement Form.pdf

This is a Conflict of Interest Statement Form required by Florida Statute 112.313 for respondents to the Miami-Dade County contract opportunity 26P-117 for Debris Management Operations (Phase 3 Response) Debris Monitoring & Consulting Services. The form mandates that all prospective contractors disclose any potential conflicts of interest related to County employment, advisory board membership, or financial interests. The solicitation seeks proposals for debris monitoring and consulting services to support Phase 3 emergency debris management operations, which encompass damage assessments and debris clearance activities performed before, during, and immediately after emergency events to restore essential traffic. The contract term is five years with three optional one-year renewal periods. Respondents must indicate whether they or their principals have affiliations with County employees, public officers, or advisory board members, whether they employ such individuals, or whether they are former County employees with less than one year of inactive service.

Prospective vendors must certify their conflict of interest status and indicate whether they will request an advisory board member waiver under Florida Statute 112.313(12). The County retains authority to review all disclosed relationships under the Florida Ethics Code and reserves the right to disqualify any vendor whose conflicts are not waived or otherwise exempt. The form requires signature and company identification from the respondent or authorized representative, with designated spaces for multiple signatories if applicable. No pricing, set-asides, incumbent information, or specific funding details are contained within this disclosure document, as it serves solely as a compliance and conflict screening mechanism for the procurement process.